Urgent Request for Medical Isotope Production Support

[garthy@owt.com (Maureen (Keren) McCarthy and Marc Garland)]

The Department of Energy is pursuing permanent closure of the Fast Flux
Test Facility (FFTF).  Of all nuclear reactors in the Western Hemisphere,
the FFTF has the most desirable target volume, neutron energy spectrum, and
neutron flux to produce the amount, quality, and variety of medical
isotopes needed for both experimental and FDA-approved diagnostic and
therapeutic medical procedures.

In December, Secretary of Energy Hazel O'Leary will make a decision on
whether to continue evaluation of future operation or to proceed with
shutdown.  She has said that public support for restart is an important
criterion in her decision.  The Nuclear Medicine Research Council (see our
home page,http://www.cbvcp.com/nmrc) has drafted a letter (below) to the
Secretary and we are now seeking endorsements from the medical and
scientific community to show her overwhelming support for restart of the
reactor as a source of medical isotopes.  (A note of caution: current plans
for restart involve an interim mission of replacing tritium in the US
weapons program prior to full-scale medical isotope production.)  We would
like to include the names of medical/scientific organizations, researchers,
and practitioners as sponsors of the letter.  If you are willing to lend
your name and/or the name of your organization please respond with your
name, title, and affiliation to:

garthy@owt.com

Please pass this message on to your colleagues and others in nuclear
medicine and encourage them to lend their support.

Sincerely,

Marc Garland


December 6, 1996

The Honorable Hazel R. O'Leary
Secretary, United States Department of Energy
1000 Independence Avenue SW
Washington, DC 20585

Dear Secretary O'Leary:

We are deeply concerned about the inadequate supply of radioisotopes for
applications in diagnostic and therapeutic medicine.  Without a clear
solution to the problem, we find it unconscionable to shut down the Fast
Flux Test Facility (FFTF) without a full review of its potential for future
operation, including isotope production.

FFTF has produced very important medical isotopes including gadolinium-153
for the detection of osteoporosis, cobalt-60 for external beam therapy and
brachytherapy of cancer, and actinium-227 for radioimmunological cancer
treatment research.  FFTF could also produce radioisotopes of immediate
need for palliation of bone pain caused by the spread of cancer metastases,
treatment of leukemia and lymphoma in patients preparing for marrow
transplantation, and as an adjunct for inducing immunosuppression in
patients undergoing life saving therapies for otherwise fatal acquired or
genetic diseases.

Diagnostic radioisotopic procedures enable early detection of cancer,
allowing early treatment at reduced cost and with increased chance of
success. Technetium-99m, a daughter product of molybdenum-99, is used in
more than 30,000 diagnostic procedures per day.  The United States
currently obtains molybdenum-99 from Canada, but their National Research
Universal reactor is scheduled for shutdown and a replacement is behind
schedule.  Restart of the Annular Core Research Reactor at the Sandia
National Laboratory will only meet U. S. molybdenum-99 needs with
significant reactor modifications and it is not capable of producing other
needed isotopes.

Fifty percent of prostate, breast, and lung cancer patients develop painful
metastatic bone cancer.  Radiopharmaceuticals offer a lower cost, more
effective treatment with minimal side effects compared to narcotic and
nonnarcotic analgesics, surgery, radiotherapy, and hormonal treatments.
Some research programs have been discontinued due to insufficient supplies
of one isotope, rhenium-186.  FFTF is capable of producing all five
isotopes in use or in clinical trials for metastatic bone pain treatment.

At the forefront of cancer research, therapeutic treatments involving
radiolabeled monoclonal antibodies have shown remarkable potential for the
treatment and possible cure of certain cancers, AIDS, arthritis, and other
diseases.  This cell-directed approach reduces the debilitating
side-effects associated with external beam radiation and chemotherapy.
Current research is being conducted predominantly with beta emitters such
as iodine-131 of which sufficient quantities are available to conduct
clinical trials; however, production will most likely not meet demand when
this therapy is approved by the Food and Drug Administration.  More
promising is the use of alpha emitters such as radium-223, a daughter
product of actinium-227, which cause less damage to healthy cells and more
effectively kill cancer cells. Unfortunately, sufficient quantities of
alpha emitters are unavailable to support even small clinical trials.  FFTF
could meet the future demand for beta emitters and is the only U. S. source
capable of producing the required alpha emitters.

Of all United States reactors, FFTF has the optimal target volume, neutron
energy spectrum, and neutron flux for production of medical isotopes.
Further, certain isotopes can only be produced in a fast reactor such as
FFTF. It is important that the United States has a medical isotope
production capability for several reasons: the significant (multibillion
dollar annually) impact isotope production will have on our trade deficit,
the fact that treatments involving short-lived isotopes rely upon a source
close to treatment centers, and reliance upon foreign sources for
ninety-five percent of our medical isotopes jeopardizes continued
development of domestic medical isotope programs.

As health care costs increase, radioisotopic diagnosis and therapy are
vital for providing the best health care possible to the broadest range of
patients by reducing the need for the costlier traditional practices of
surgery, chemotherapy, and external radiation treatment.  More important
than the cost of these health care options is the patients' quality of
life.  Patient quality of life is significantly diminished by whole-body
chemotherapy, damage to healthy tissue associated with external beam
radiation, and the debilitating effects of invasive surgical procedures.
Radioisotopic diagnosis and therapy can greatly reduce this suffering
through early diagnosis and less destructive treatment.

While we cannot precisely predict the future market for medical isotopes,
we are certain of this: without FFTF, the United States will certainly not
be capable of producing the radioisotopes required for near-term medical
purposes; with FFTF, United States production could support most medical
programs.  We strongly encourage you to terminate all shutdown activities
and move forward with FFTF restart.